Never Events, Hospital Acquired and Iatrogenic Conditions: Never a Reason for an Insurance Company to Deny Medical Treatment!

Seek the help of an attorney immediately if your medical insurance company denies you benefits claiming your condition is the result of a Never Event, Hospital Acquired Condition, or an Iatrogenic Condition!

What Are Never Events, Hospital Acquired Conditions, and Iatrogenic Conditions?

Never Events (“NA”) are things that…well…should never happen, things like operating on the wrong knee or cutting off the wrong testicle. Yikes! They should never happen because hospitals and medical providers should have protocols in place to make sure they have the right person, right site (body part), and right surgery. If a wrong person, wrong part, or wrong site surgery occurs, it’s because someone failed to follow protocol.

Hospital Acquired Conditions (“HAC”) are conditions patients develop from being in the hospital, like a staph infection following a surgery. Iatrogenic Conditions (“IA”) are conditions a patient develops because of treatment, e.g., osteoporosis (bone loss) from taking steroids.

In around 2008, Medicare enacted policies to use financial pressure to encourage hospitals and providers to be more careful by announcing it would stop paying them for NEs and some HACs and IAs.

The purpose of the policy was to punish offending hospitals and providers and to economically incentivize best practices, but since patients were the victims, they always received the necessary medical care. Could one imagine Medicare telling a patient Medicare would not cover the antibiotics needed to treat the patient’s HAC staph infection? Or telling a patient that Medicare would not pay for the operation on the correct knee after a surgeon operated on the wrong knee? Of course not.

Insurance Bad Faith

But that’s exactly what insurance companies started doing! Medicare’s policy successfully reduced medical errors and costs, so insurers around the country soon implemented similar policies. However, insurance companies, being what they are, soon started abusing the policy by refusing to authorize treatment necessary to help patients recover from NEs, HACs and IAs. Yet, patients, who are the victims in such cases, are almost always due medical treatment for NEs, HACs, and IAs.

If you have been denied coverage for such reasons, contact me immediately! You likely have many claims you can make against your insurance company.